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Anne Klibanski, Laurence Katznelson, Medical Therapy of Prolactinomas in Men, The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 4, 1 April 2001, Pages 1838–1846, https://doi.org/10.1210/jcem.86.4.7436-5
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To the editor:
Drs. Delgrange and Donckier have raised several issues concerning our study regarding primary dopamine agonist treatment in men with prolactinomas. As the authors correctly state, our study shows that the rate of PRL normalization in response to dopamine agonists is comparable in men with micro- or macroprolactinomas. These male subjects had not undergone surgery or radiation therapy and, thus, were treated with dopamine agonists alone. The men presented with a spectrum of radiographic and clinical findings, and the heterogeneity of prolactinoma presentation is well established. The diagnosis of “idiopathic hyperprolactinemia” is somewhat problematic because such patients are often found to have lesions either at surgery or on magnetic resonance imaging scans as the sensitivity of such scans improves over time. As Drs. Delgrange and Donckier suggest, invasive macroprolactinomas may respond differently to dopamine agonists than noninvasive ones. However, the intent of the study was to present the results of men with prolactinomas treated with medical management alone without preselecting a defined group. Prolactinoma responsiveness to therapy is often difficult to judge based on proven biologic, endocrinologic, or pathologic classification. Invasive prolactinomas may respond to dopamine agonist therapy with marked decreases in tumor size and normalization of PRL levels. In contrast, patients with microprolactinomas may show resistance to dopamine agonist administration presumable due to differences in dopamine receptor concentration or binding characteristics. Therefore, we categorized patients based on magnetic resonance imaging scan size.
